İbrahim İYİGÜN, Yılmaz Niyazi YAZMAN, Erhan VAROĞLU, Akın LEVENT, Mustafa YILMAZ

Jeneralize ve parsiyel epilepsili hastalarda EEG, BT, MRI ve spect bulguları

Jeneralize ve parsiyel epilepsilerde epileptik fokusun lokalizasyonu ve lateralizasyonunu saptamak için 11'i jeneralize, 19'u parsiyel olmak üzere toplam 30 epilepsili hastada yüzeyel EEG, BT, MRI ve interiktal SPECT tetkiki yapıldı. Bunların sonucu karşılaştırıldı. BT ile 7 (%23.3), MRI ile 13 (%43.3), EEG ile 21(%70) ve interiktal SPECT ile 26 (%86.7) hastada patolojik bulgu saptandı. SPECT ile EEG, BT ve MRI'dan daha yüksek oranda patolojik bulgu tespit edildi. SPECT ile gösterilen patolojik alanlar; EEG, BT ve MRI ile tespit edilen patolojik bölgeler ile büyük ölçüde uyumlu idi ve daha geniş alanları içeriyordu. MRI, BT'nin gösterdiği tüm lezyonları gösterdiği gibi BT'de tespit edilmeyen 6 lezyonu da tespit etmiştir. MRI da gösterilemeyen hiç bir lezyon BT'de de gösterilememiştir. EEG'deki anormalliklerin lokalizasyonu ile BT, MRI ve SPECT ile tespit edilen patolojik sahalar arasında büyük oranda uyum vardı. Sonuç olarak çalışmamızda epileptojenik odağın belirlenmesinde SPECT'in diğer tetkiklere (EEG, BT, MRI) nazaran daha yüksek oranda anomali göstermesine karşın SPECT gibi fonksiyonel incelemeler, EEG gibi eiektrofizyolojik, BT ve MRI gibi anatomik incelemelerin yerini hiç bir zaman tutmaz. Bu yüzden epilepsinin teşhisinde, etyolojisinin aydınlatılmasında ve cerrahiye aday hastalarda . epileptojenik fokusun doğru teşhisinde EEG, BT, .MRI ve SPECT tetkiklerinden ortak olarak yararlanılmalıdır,

EEG, CT, MRI and spect findings in patients with generalize and partial epilepsy

This study was carried out to detect the localisation and the lateralisation of epileptic focus using superficial EEG, CT, MRI and interictal SPECT in 30 epileptic (11 generalize, 9 partial epilepsy) patients. There were 7 (23.3 %) patients with pathologic findings on CT, 13 (43.3 %) patients on MRI, 21 (70 %) patients on EEG and 26 (86.7 %) patients on interictal SPECT. in addition to correlation cerebral abnormalities on these for diagnostic methods, in some cases cerebral perfusion abnormalities larger than those of CT and MRI were also detected on interictal SPECT. :Any cerebral lesion failed to show on MRI also could not shown on CT. Hovvever, additional 6 cerebral lesion that could not be determined on CT, were detected on MRI. The localisation of EEG abnormalities had close correlation with the pathologic findings detected on CT, MRI and SPECT. in conclusion, although SPECT is more valuable diagnostic method than CT, MRI and EEG'for detecting epileptogenic focus, it can never be replaced for electrophysiologic (EEG) and morphologic (CT, MRI) methods. Therefore, electrophysiologic, morphologic and functional diagnostic procedures should be cooperatively used to detect epileptogenic focus and to enlighten the ethiology of epilepsy in epileptogenic patients and to select candidates for surgery.

PDF

___

1. Arguner A. Epi|epsi. Özekmekçi S, Apaydın H (eds). Ndro|oji. İstanbü|:
2. Adams RD, Viclor M. Principles of Neurology. Singapore: Me Graw-
3. Ra'due EW,'Scollo-L v ’zori G. Compuled tomography and magnetic resonance imaging in epileptic seizures. Eur Neurol 1994; 34:55-57
4. G0kyigit A. Epi|epside SPECT. K|inik Ge|i§im 1993;8 :2536-2538
5. Devious MD, Leroy RF, Homan RW. Single photon emission computerize tomography in epi|egsy. Semin Nuc| Med 1990; 20:325-
6. Pedley TA, Schever ML, Walczak TS. Epilepsy. In: Rowland PL (ed). M I’ ok of Neurology, 9* ed., New York:Williams &WiIkins
7. Grunwald F, Menzel C, Pavics L,et al. Ictal and interictal b‹ain SPECT etium 99 m- ECD . J Nucl Med 1994; 35 1896* 1901
8. Cordes M, Christe W, Henkes H, el al. Focal egilepsies: HM-PAO SPECT compared with CT, MR and EEG. J Comput Assisi Tomogr 1990; 14: 402-69
9. Jackson GO, Berkotic SF, Duncan JS, Connell A. Optimizing the lerosis using MR imaging. AJNR 1993 1 753-7 ”’“ ' *
10. Holm‘es GL. Electroenceghalographic and neuroradiologic evaluation of cI’iiIdren with epilepsy. Ped Clin Noñh Am, 1989;36:395-420
11. Theodore WH, Dorwoñ RH, Holmes MD, et at. Neuroimaging in refractory pañial seizures: comparision of PET, CT and MRI. Neurology 1986; 36:750-759
12. Guberman, A. The role of computed cranial tomography in epilepsy Can J Neurol Sci 1983; 10: 16-21
13. Schômer W, Meencke HJ, Fe|ô‹ R. Temporal |obe, epi|epsy: comparison of CT and MRI imaging. AJR 1987; 149:1231-1239
14. Young AC, Conslanzi JB, Mohr PD, Forbes WS. |s routine 1t ed axial tomograghy in epilepsy woñh while* Lancet 1982;
15. la hari B, Gunderso0 CH, Wippold F, et al. Magnetic résonance imaging in pañial complet epilepsy. Arch Neural 1986; 43: 869-872
16. Hougaard K, Oikawa T, Sveinsdottii E, sl‹inoj E, Ingvar DH, Lassen R i bral blood gow in foœl coñical egilepsy. Arch Neuro|
17. Grant R,' Hadley DM, Condon B, et al. MRI in the management of resislanl focal epilepsy: pathologiœl case report and experience of 12 cases. J Neural Neurosurg Psychial 1g87; 50:1529-1532
18. Rowe CC, Berkovic SF, Austin MC, McKay WJ, Bladin FF. Patterns of posticlal cerebral blood flow in temporal lobe epilepsy: qualitative and quantitative analysis. Neurology 1991;41: 109D1103
19. Lee BI, Morkend ON, Siddigui AR, e al. SPECT brain imaging using mplex partia| seizure. Neuro|ogy 1986; 36: 1471 M4. ”" "
20. Biefsack HJ, Grünwald F, Kropp J. Single pholon emission cornputed lomography imaginé of brain lumours. Semin Nucl Med 1991; 21:2